eLearning to enhance physician patient communication: a pilot test of "doc.com" and "WebEncounter" in teaching bad news delivery.

BACKGROUND: Physician-patient communication skills help determine the nature and quality of diagnostic information elicited from patients, the quality of the physician's counseling, and the patient's adherence to treatment. In spite of their importance, surveys have demonstrated a wide variability and deficiencies in the teaching of these skills. AIM: Describe two specific methodologies for teaching physician-patient communication skills developed at our institution and pilot test them for effectiveness. METHODS: Between 2004 and 2009 we developed "doc.com," a series of 41 media-rich online modules on all aspects of healthcare communication jointly with the American Academy on Communication in Healthcare. Starting in 2006, we expanded our pre-existing experience with the videoconferencing system "WebOSCE" into the online application "WebEncounter." This new methodology combines practice of communication skills on standardized patients with structured assessment and constructive feedback. We had three randomized groups: controls who did only the assessment parts of a WebOSCE on two occasions, a doc.com group who had doc.com in between the assessment occasions, and a combined group that had both doc.com and a WebEncounter between assessments. RESULTS/CONCLUSION: We found significant improvement in skills as components were added, and the training program was well received.

The impact of the changing health care environment on the health and well-being of faculty at four medical schools.

PURPOSE: Increased pressure for clinical and research productivity and decreased control over the work environment have been reported to have adverse impacts on academic faculty in limited studies. The authors examined whether work-related stressors in academic medicine negatively affected the physical and mental health, as well as life and job satisfaction, of academic medical school faculty. METHOD: A 136-item self-administered anonymous questionnaire modified from a small 1984 study was distributed to 3,519 academic faculty at four U.S. medical schools following institutional review board approval at each school. Validated scales measuring depression, anxiety, work strain, and job and life satisfaction; a checklist of common physical and mental health symptoms; and questions about the impact of institutional financial stability, colleague attrition, and other work-related perceptions were used. Responses were analyzed by sex, academic rank, age, marital status, faculty discipline, and medical school. RESULTS: Responses were received from 1,951 full-time academic physicians and basic science faculty, a 54.3% response rate. Twenty percent of faculty, almost equal by sex, had significant levels of depressive symptoms, with higher levels in younger faculty. Perception of financial instability was associated with greater levels of work strain, depression, and anxiety. Significant numbers of faculty acknowledged that work-related strain negatively affected their mental health and job satisfaction, but not life satisfaction or physical health. Specialties were differentially affected. CONCLUSIONS: High levels of depression, anxiety, and job dissatisfaction-especially in younger faculty-raise concerns about the well-being of academic faculty and its impact on trainees and patient care. Increased awareness of these stressors should guide faculty support and development programs to ensure productive, stable faculty.

A survey of residents' attitudes and practices in screening for, managing, and documenting domestic violence.

OBJECTIVE: We conducted this study to identify residents' limitations in screening for, documenting, and managing domestic violence (DV) and to focus future educational interventions. METHODS: We administered a detailed survey to 103 internal medicine residents from 4 university-affiliated programs to ascertain their attitudes about and practices in screening for, documenting, and managing DV. RESULTS: Most residents agreed that DV is a significant health care problem (87%) and one in which physicians can intervene effectively (77%), yet 37% reported not screening for DV. Residents who said they do not screen reported a variety of mitigating factors, from uncertainty about how to screen for and manage DV, to fear of insulting or angering the patient. Eighty-two percent stated that they would document DV in the chart, but 51% had reasons for not documenting DV, ranging from fear that the patient's partner might harm the patient or the physician to concern that the patient may not be telling the truth. Fifty-seven percent of residents said they would ask about DV more often if state law mandated it. When asked to choose which management interventions were helpful or unhelpful, many residents made incorrect, potentially injurious choices. CONCLUSION: Many residents reported beliefs and practices that could inhibit optimal care of DV victims. Educational interventions should be directed at remedying residents' gaps in knowledge and attitudes to improve screening for, documenting, and managing DV.

Evaluating surgeons' informed decision making skills: pilot test using a videoconferenced standardised patient.

BACKGROUND: Standardised patients (SPs) are effective in evaluating communication skills, but not every training site may have the resources to develop and maintain SP programmes. OBJECTIVES: To test whether videoconferencing technology (VT) could enable an interaction between an SP and an orthopaedic surgeon that would allow the SP to accurately evaluate the surgeon's informed decision making (IDM) skills. We also assessed whether this sort of interaction was acceptable to orthopaedic surgeons as a means of learning IDM skills. METHODS: We trained an SP to represent a 75-year-old woman considering hip replacement surgery. Orthopaedic surgeons in Chicago individually consulted with the SP in Philadelphia; each participant could see and hear the other on large television screens. The SP evaluated the surgeons' advice using a 23-item checklist of IDM elements, and gave each surgeon verbal and written feedback on his IDM skills. The surgeons then gave their evaluations of the exercise. RESULTS: Twenty-two surgeons completed the project. The SP was > or = 80% accurate in classifying 20 of the 23 IDM skills when compared to a clinician rater. Although 12 (55%) of the orthopaedic surgeons felt that some aspects of the technology were distracting, most were pleased with it, and 19 of 22 (86%) would recommend the videoconferenced SP interaction to their colleagues as a means of learning IDM skills. CONCLUSIONS: These results suggest that VT allows accurate evaluation of IDM skills in a format that is acceptable to orthopaedic surgeons. Videoconferencing technology may be useful in long-distance SP communication assessment for a variety of learners.

An assessment of residents' abilities to detect and manage domestic violence.

Despite increased awareness of domestic violence (DV), little is known about residents' preparedness to diagnose and respond appropriately to abuse victims. We designed a pilot study to examine this. Seventy-one internal medicine residents participated in a 10-station standardized patient-based Clinical Skills Assessment. Forty (56%) were male and 31 (44%) were female; 46 (65%) were PGY I; 63 (89%) were trained internationally. One station presented a woman with headaches, whose underlying issue was DV. Forty (56%) residents correctly diagnosed DV. Thirty referred the patient for DV counseling. Eighteen addressed immediate safety concerns, and 23 asked about child abuse. Forty-eight (68%) made 1 or more incorrect recommendations. Thirty-six (51%) ordered unnecessary tests. Residents who did not diagnose DV spent nearly twice as much per patient on work-up (mean, $942.00), compared to those who diagnosed DV (mean, $421.00). Use of certain interviewing skills appeared to promote elicitation of DV. Assessment-driven educational interventions could help trainees improve their recognition of DV and make appropriate and cost-effective management choices.